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April 10, 2011

Diagnosing Ovarian Cancer

Ovarian cancer is one of the most difficult cancers to diagnose and catch at an early stage.  Early warning signs actually mimic digestive disorders and are easily overlooked or blamed on our dietary habits.  If a woman has abdominal pain or bloating that persists for several weeks, and does not respond to standard natural therapies, then she should remind her doctor to rule out ovarian cancer.  If a woman starts to lose her appetite or starts to feel full quickly when eating, then she should consider asking her doctor about ovarian cancer. Other symptoms include vaginal bleeding, sense of heaviness in the pelvis, swollen abdomen, unexplained back pain that gets worse over time, and unexplained weight loss or weight gain.

In diagnosing ovarian cancer, doctors review the severity and duration of symptoms, and then follow up with physical exams and lab tests.

1)    Manual pelvic exam – This examination is done every time a pap or thin prep test is performed as part of an annual well woman’s exam.  Although the pap/thin prep tests are designed to rule out cervical cancer, the manual exam that follows gives the doctor a lot of information about the health of the organs in the pelvis.  Through palpation of the uterus and ovaries, the doctor may be able to discern the presence of uterine fibroids, ovarian cysts or other unusual growths that may warrant further testing.  If ovarian cancer is suspected based on reported symptoms, this will be the first exam performed by a doctor.

2)    Pelvic ultrasound – Imaging of the pelvis helps confirm the size, shape and location of the pelvic organs as well as the presence of any other growths.  This will typically be the next lab ordered after the manual exam.  Bloodwork may also be ordered.

3)    Tissue sample – The first two steps are not enough to diagnose ovarian cancer.  If the symptoms, manual exam, and ultrasound suggest unusual cell growth, the next step is often biopsy or removal of one ovary for review by a pathologist.  If cancer is found, then follow up with an oncologist to decide the best course of treatment.

Patients often ask about the CA-125 test, especially if they have a strong history of cancer in their family.  This blood test is not included in an annual well woman’s examination because it is not a valid screening test.  CA-125 is a protein found on the surface of healthy ovarian cells.  The definition of cancer is unregulated cell growth, so a blood test indicating high levels of CA-125 in the body should be a clear sign of ovarian cancer, right?  Not so fast.  CA-125 levels in the blood are elevated during pregnancy, as well as in the presence of endometriosis, ovarian cysts, uterine fibroids, and normal menstruation.  In addition, early stage ovarian cancer does not typically elevate CA-125 levels.  Therefore a negative CA-125 test does not rule out ovarian cancer and a positive CA-1235 does not diagnose ovarian cancer.  So what’s the point of that test?  Once a woman has been diagnosed with cancer, and is working with an oncologist, the oncologist may run this test periodically to monitor the efficacy of their treatment protocol.

One screening test that does assess a woman’s risk of developing ovarian cancer is the genetic screening for BRCA 1 and BRCA 2.  These genes are responsible for a small number of cases of ovarian cancer.  Any woman with a family history of breast cancer or ovarian cancer should consider this test.  Due to the generality of the symptoms of ovarian cancer, patients must be their own best advocate.  If you are concerned about your family history and believe you may be at risk, insist on further imaging and testing from your doctor.

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